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    2nd Surgical Opinions?

    While bicycling, you fall and break something on your bod that needs a significant surgical repair. Your PCP refers you to Doctor X. Do you get a 2nd surgical opinion prior to having the surgery? Why or why not?

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    You broke WHAT?
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    You're supposed to be the customer and have the right of choosing your own service provider.

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    First i check with insurance company to ensure thay surgeon X is covered in network or preferred provider.
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    Quote Originally Posted by nobodyhere View Post
    While bicycling, you fall and break something on your bod that needs a significant surgical repair. Your PCP refers you to Doctor X. Do you get a 2nd surgical opinion prior to having the surgery? Why or why not?
    I am a fan of second opinions.

    Years ago, I broke my achillies tendon playing basketball. The doc I went to highly regarded (he was the team ortho for the California Angels), and he recommended surgery to repair it. I still got a second opinion.

    Most insurance carriers will gladly pay for a second opinion, and most docs welcome them. Why not? If nothing else, if the result is less than you expect, you'll know that you did all you could to make sure it was the right decision.
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    From Medicare:

    Getting a second opinion before surgery


    A second opinion is when a doctor other than your regular doctor gives you his or her view about your health problem and how to treat it. It can help you make a more informed decision about your care.
    When your doctor says you have a health problem that needs surgery, you have the right to:

    • Know and understand your treatment choices
    • Have another doctor look at those choices with you (second opinion)
    • Participate in treatment decisions by making your wishes known

    Find out when a second opinion is covered.
    When to get a second opinion


    • If your doctor says you need surgery to diagnose or treat a health problem that isn't an emergency. It's up to you to decide when and if you'll have surgery.
    • If your doctor tells you that you should have certain kinds of major non-surgical procedures. Medicare doesn't pay for surgeries or procedures that aren't medically necessary, like cosmetic surgery. This means that Medicare won't pay for second opinions for surgeries or procedures that aren't medically necessary.

    Note
    Don't wait for a second opinion if you need emergency surgery. Some emergencies may require surgery right away— like for accidental injuries, acute appendicitis, or for a blood clot or aneurysm.

    Finding a doctor for a second opinion


    • Make sure the doctor giving the second opinion accepts Medicare.Find a doctor that accepts Medicare.
    • Ask your doctor for the name of another doctor to see for a second opinion. Don't hesitate to ask—most doctors want you to get a second opinion.
    • You can also ask another doctor you trust to recommend a doctor.
    • Ask your local medical society for the names of doctors who treat your illness or injury. Your local library can help you find your local medical society.

    What to do when you get a second opinion

    Before you visit the second doctor, you may want to:

    • Ask your doctor to send your medical records to the doctor giving the second opinion. That way, you may not have to repeat the tests you already had. Also, call the second doctor's office and make sure they got your records.
    • Write down a list of questions to take with you to the appointment.
    • Ask a friend or loved one to go to the appointment with you.

    During the visit with the second doctor, you may want to:

    • Tell the doctor what surgery you're considering.
    • Tell the doctor what tests you already had.
    • Ask the questions you have on your list and encourage your friend or loved one to ask any questions that he or she may have.

    Note
    The second doctor may ask you to get additional tests as a result of the visit. Medicare will help pay for these tests just as it helps pay for other services that are medically necessary.

    What if the first & second opinions are different?

    If the second doctor doesn't agree with the first, you may feel unsure what to do. In that case, you may want to:

    • Talk more about your condition with your first doctor.
    • Talk to a third doctor. Medicare helps pay for a third opinion.

    Getting a second opinion doesn't mean you have to change doctors. You choose which doctor you want to do your surgery.



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    Countdown to 65!!! Pamestique's Avatar
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    I recently went through a very serious accident requiring surgery.

    When I met with the ortho surgeon, not only did he fully explain what needed to be done; he referred me to the internet and told me to educate myself on the injury, required surgery and prognosis so I felt comfortable with his advice (everything I read said surgery was the ONLY option). In addition, I have been going to this ortho medical office since 1975... the older doctor I first saw has retired but his associates are literally top in their field.

    In that instance I did not seek a second opinion. I confirmed the prognosis and required surgery and I knew the doctor was top-notch.

    I have in the past sought a second opinion. I was not comfident the doctor understood the issues and what needed to be done. I went to a second surgeon, and confirmed what I thought and ended up having surgery by the second doctor.

    If you have issues and concerns, ask a million questions. If the medical office is not cooperative or you can't get answers, then a second opinion makes sense.
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    of course, you get a second opinion. You know what they call the guy who finished last in his class in med school, don't you? Answer: Doctor.

    J.

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    In a sense, you're naturally getting a second opinion.
    1 - Your PCP
    2 - Orthopedic Surgeon.

    Of course, surgeons tend to be a bit myopic in their approach to solutions to problems. But, your PCP should also have given you an idea of what to expect.

    There is, of course, the option of doing nothing. And, that would depend on the nature of the injury, and expected disability.

    Are there physician reviews on the internet? That might also be beneficial to review.

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    If something is broken why do you need a second opinion?

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    Yes, and keep getting opinions until you're satisfied that you understand and agree with the risks and reasons behind the recommendations, whether it's for surgery or conservative treatment.

    I wish I had listened to my own misgivings when my surgeon advised against surgery. He brought a staff trauma surgeon to see me, and he had the same advice. They were both wrong, and after a couple of months I fired them and went to another center. The surgeon there still didn't think a plate was advisable, and I asked for yet another opinion. From that sequence you might think that I was shopping for the opinion that I wanted, but I wasn't. I was just looking for the surgeon who could correctly justify his advice based on specifics of my injury, and on the medical facts that I knew to be correct. It really was the 4th guy before that happened.

    They all sound knowledgeable and confident, but I learned that you have to actively evaluate their knowledge and their advice. It's ultimately your decision and when you get right down to it you're hiring them for a job. If they can't explain their decision, or you've got a nagging doubt that something beyond your well-being is involved, take it under advisement and on the the next guy.

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    Quote Originally Posted by CliffordK View Post
    In a sense, you're naturally getting a second opinion.
    1 - Your PCP
    2 - Orthopedic Surgeon.
    I would disagree with this. You need to get second opinions from two (or more) surgeons if you are looking at surgery. Getting a second opinion from a physician who is not an expert in the field is not the same thing.

    Before getting that second opinion, it's wise to be up on the surgery and have the tradeoffs explained to you and the options for how to do the surgery explained. Also, it's important to know how many of a particular surgery that surgeon does and with what frequency. The more repetitions a surgeon does is obviously beneficial and the more familiarity that surgeon has with the procedural choices and technology also will yield benefits in surgery especially if there are complications during or after surgery.

    Some years ago, my wife had a difficult blown disk high up in her neck where the surgery is considerably more difficult and risky. Since there are no reliable repositories of surgeon competencies because no surgeon wants to share their failures, one has to ask around and develop a set of criteria to understand who is good and who is not. What we did, and what I would recommend if you are not sure of what to do, is to go and get good advice and then pay for it. What we did was to find one of the top guys in the field, consult with him on what the appropriate approach would be and what a good treatment plan is, criteria to evaluate and select a surgeon. We then used that to find a surgeon. The guy with whom we consulted was not available to us for the surgery for reasons of both geography and insurance plan (another story in itself). That office visit gave us a better means of evaluating who was good and who wasn't.

    The guy we wound up using turned out that all he did was this kind of surgery and he did 4 per day 2-3 days per week. After the fact, I made contact with a friend of mine who I (finally) recalled was in the spinal rehab business and her guidance confirmed our selection. The best advice she gave us had two parts. The first was to "always remember, it's a business first." The second was to understand that you hire a surgeon for their skill in the OR not for their bedside manner. All of that was true - when we asked surgeons how many of these they did, we got answers that ranged from 1 per month to 1 per week to 12 per week. While not generally true, the best talkers also had the least regular practice at that procedure. In other words, you could not judge their competency as a surgeon by their bedside manner.

    Remembering it's a business first is important. When we called the surgeon who we felt would be good based on our criteria, research, and for a second opinion, we were first told that the waiting time to see him was 6 weeks. This wasn't going to work. So I told them that we were looking for a second opinion, we knew surgery was imminent and indicated and that we were looking to pick the surgeon and schedule this. We had an appt for two days later and the surgeon actually scheduled the surgery for a few days after that on what was the Friday after Thanksgiving. Boom, done. Never forget it's a business.

    How to do this was advice given to me by one of the senior executives of one of the best known medical centers in the country (he is also a physician) who is a family friend. While YMMV, it seemed to me to be good advice and it worked for us.

    J.
    Last edited by JohnJ80; 10-29-15 at 04:42 PM.

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    Quote Originally Posted by CliffordK View Post
    In a sense, you're naturally getting a second opinion.
    1 - Your PCP
    2 - Orthopedic Surgeon.

    Of course, surgeons tend to be a bit myopic in their approach to solutions to problems. But, your PCP should also have given you an idea of what to expect.

    There is, of course, the option of doing nothing. And, that would depend on the nature of the injury, and expected disability.

    Are there physician reviews on the internet? That might also be beneficial to review.
    There are records at whatever your state licensing medical board is called. A friend, who was ruined for life by a surgeon, failed to check. We checked post-surgery and found two legal cases against him in another state. He apparently moved out of that state to another state. Yes, surgeons get sued, BUT, this would be a warning sign. Since then, he has jumped from practice to practice and hospital to hospital in our metro area.

    There are also reviews on various web sites - take them for what they are worth.

    When I had my heart surgery, I was told by my cardiologist to avoid the folks in my larger hometown, as they were not skilled in this procedure. I searched the nation gathering all the info I could from wherever, visited web sites and listservs of others who had gone through the procedure, got as much info about "outcomes" - surgeons never want to tell you this - and chose one at the Cleveland Clinic. And, I talked with two other surgeons and got their opinions. I asked one of them who he would have do the surgery, and, bingo, he stated the guy I finally chose and had been considering.
    Last edited by nobodyhere; 10-29-15 at 08:03 PM.

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    The answer really depends on what you broke and how bad it was. When I broke my distal radius into 4 pieces last year (with joint involvement) it was a no-brainer that surgery would lead to a quicker healing and better outcome. The only opinion that I needed was about the "when" and "who". I decided the "when" myself because I was not interested in waiting a few weeks to see if surgery was avoidable. The chances of 4 pieces of bone coming together on their own and not affecting the joint were unlikely. The "who" was a matter of getting recommendations from medical colleagues and checking availability.

    When I developed a couple of ruptured disks about 10 years ago, I got opinions from both a sports medicine doc and a neurosurgeon, rejected both and went to a PT who helped me build my core muscles and set me on a maintenance regimen that has kept me relatively pain free for a decade. It's not about how many opinions that you get, it's understanding that you have the most skin in the game and thus the most to gain or lose.
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    Quote Originally Posted by JohnJ80 View Post
    I would disagree with this. You need to get second opinions from two (or more) surgeons if you are looking at surgery. Getting a second opinion from a physician who is not an expert in the field is not the same thing.

    Before getting that second opinion, it's wise to be up on the surgery and have the tradeoffs explained to you and the options for how to do the surgery explained. Also, it's important to know how many of a particular surgery that surgeon does and with what frequency. The more repetitions a surgeon does is obviously beneficial and the more familiarity that surgeon has with the procedural choices and technology also will yield benefits in surgery especially if there are complications during or after surgery.
    +100 on this. Surgical skill is one thing, but nothing substitutes for a lot of experience with surgeries similar to the one you are contemplating.

    I learned this the hard way when I had a cyst removed by an oncological head and neck surgeon (it was originally opined as likely cancer). Since it was a simple surgery to be performed by a somewhat renowned surgeon in a very delicate specialty, I opted to just stay with him.

    I ended up needing two other surgeries to clean up the mess and had a lot more scar tissue than I should have. The (frankly great) oral surgeon that did the clean up (a teaching professor at a local university) explained the outcome and gave me that same good advice. Go with the surgeon for whom your procedure is routine ... done many many times a year. They'll have encountered what problems you're likely to face already.
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    Since I live in a state where the standard of care in the medical community is somewhat poor and often unnecessarily lethal, I wouldn't even bother seeing the first surgeon before I went out of state to get my first two opinions.

    Over a decade ago, I drove my heel bone up through my ankle which necessitated bolting things back together. I wanted an X-ray before I made any decisions, so I went to the local ER (immediately after the injury). The poorly trained physician on duty (his own description, by the way) called in an orthopedic consult. She concurred with my reading of the X-ray and wanted to do the surgery. She added that since I was so old (in my forties), it wasn't like things had to be done perfectly. I told her I was riding 300-450 miles per week through the coast range and that I would be heading south for the surgery. She was offended, but that made two of us so it seemed fair.

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    Senior Member Looigi's Avatar
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    I like to get a third opinion as well. I also try to use doc/surgeons who specialized in sports medicine.
    Eschew simplistic dogma.

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    As a Disabled Veteran the opportunity to get an appointment within 120 days is eclipsed by the inability to find someone who is not doing their residency to get a reliable opinion as they leave the room to get the Chief of the specialty because they cannot make a decision or are suffering from attention deficit disorder.

    I'm envious of you guys who actually have choices and alternatives.

    I was given a stint and then a shot of morphine and 5 minutes later released to drive home! I called a friend to come get me!
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    Countdown to 65!!! Pamestique's Avatar
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    Quote Originally Posted by B. Carfree View Post
    Over a decade ago, I drove my heel bone up through my ankle which necessitated bolting things back together. I wanted an X-ray before I made any decisions, so I went to the local ER (immediately after the injury). The poorly trained physician on duty (his own description, by the way) called in an orthopedic consult. She concurred with my reading of the X-ray and wanted to do the surgery. .
    I have learned not to rely on ER doctors and hospital surgeons and their advice. When I suffered the Maissoneuve fracture in April, the ER doctor didn't even notice my ankle was blown out; he only noted the fracture fibula and sent me on my way with a sprint and crutches. I was told to consult an ortho within the week. I made the ortho appointment and the doctor immediately acted concerned about the seriousness of my ankle injury... ankle injury - what ankle injury I thought I was here to get my fractured leg set! A week later I had bolts through my ankle... if I relied on the ER and ER only I would not had an early repair of a serious injury. Also in 2005, I was sent home from the ER with an undiagnosed collarbone fracture... ER doctors are great but there are reasons other doctors specialize...
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    Absolutely a second opinion is highly recommended case in point:
    Earlier this year I developed an inguinal hernia and my primary sent me to a surgeon who wanted to "open me up" with a 6 inch incision and off the bike for at least 6 weeks. Not satisfied I got a second opinion and the second doctor repairs laparoscopically the hernia from behind with 2 small holes and was off the bike for only 3 days and little discomfort!
    Go for a second opinion for sure if you have of course the luxury of time!
    Good luck!

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    Quote Originally Posted by Pamestique View Post
    I have learned not to rely on ER doctors and hospital surgeons and their advice. When I suffered the Maissoneuve fracture in April, the ER doctor didn't even notice my ankle was blown out; he only noted the fracture fibula and sent me on my way with a sprint and crutches. I was told to consult an ortho within the week. I made the ortho appointment and the doctor immediately acted concerned about the seriousness of my ankle injury... ankle injury - what ankle injury I thought I was here to get my fractured leg set! A week later I had bolts through my ankle... if I relied on the ER and ER only I would not had an early repair of a serious injury. Also in 2005, I was sent home from the ER with an undiagnosed collarbone fracture... ER doctors are great but there are reasons other doctors specialize...
    Exactly right. ER docs are there to save your life and/or stabilize your condition and then triage you onto the next level of care. It is not the endpoint for treatment.

    Quote Originally Posted by VNA View Post
    Absolutely a second opinion is highly recommended case in point:
    Earlier this year I developed an inguinal hernia and my primary sent me to a surgeon who wanted to "open me up" with a 6 inch incision and off the bike for at least 6 weeks. Not satisfied I got a second opinion and the second doctor repairs laparoscopically the hernia from behind with 2 small holes and was off the bike for only 3 days and little discomfort!
    Go for a second opinion for sure if you have of course the luxury of time!
    Good luck!
    So true - medical technology is pretty rapidly advancing and getting to a doc who keeps up is important. As I get older, I have less interest in investing in a long recovery time when there is a way to get to the solution faster.

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    Quote Originally Posted by Pamestique View Post
    I have learned not to rely on ER doctors and hospital surgeons and their advice.
    Yeah, I just needed them for the X-ray. The ortho consult was an entertaining bonus. If I would have been near one of my veterinarian friends, I would have used their X-ray machine instead.

    I actually learned about ER physicians the hard way many years ago. I had been planning a bike tour from the Bay Area to Death Valley, where my then-girlfriend had a summer job, but things fell through. We decided to meet in Yosemite and go backpacking for a week instead. I took ill towards the end of our trip and stopped in to see a physician who gave me some antibiotics for the secondary throat infection. A few days later, once again back home, I noticed that my lower right leg had mysteriously swelled up a huge amount. Since my physician was out of town, I went down to the local hospital and saw the pig-in-a-poke ER physician. He doubled my antibiotic dosage and sent me off.

    If I wasn't so feverish, I might have realized that doubling the dosage of something that whatever bacteria I had was obviously resistant to wasn't going to help matters. Fortunately, when I returned two days later a much better physician was on duty. When he finished cursing about the poor care I had received, he cleared what would become their new active-infection room and removed over a liter of pus from my very Staph. infected leg. He had to guess on what antibiotic it would work. If he had guessed wrong, I would have lost my lower leg. Lucky me, he made a good choice.

    I went from 195 pounds to 155 pounds in less than two weeks, but this isn't a weight loss program I would advise for anyone. Shortly after all this happened, I ran into an ambulance driving friend. He told me that the initial ER physician I had seen is known to be a quack. He does everything he can to transport his patients elsewhere when that particular physician is on duty.

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    One thing to remember about second opinions: if the MD giving the first opinion is recognized in that area, or considered an "expert," no other MD is likely to contradict the first. No one wants to throw down against an expert--- that's just not how health care (really, disease maintenance) is practiced in this country. Read "The God Complex," by Chris Titus. At any rate, Ortho surgery is like the auto mechanics of medicine--- it's mostly mechanical correction.
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    Quote Originally Posted by Needles View Post
    One thing to remember about second opinions: if the MD giving the first opinion is recognized in that area, or considered an "expert," no other MD is likely to contradict the first. No one wants to throw down against an expert--- that's just not how health care (really, disease maintenance) is practiced in this country. Read "The God Complex," by Chris Titus.
    Absolutely true. If they went through the same training, the doctors rendering the first and second opinion may say exactly the same "by the book" thing.

    Second and third opinions make a lot of sense in cancer treatment, however, if one sees a surgeon, a radiation oncologist, and a chemotherapist. "When your tool is a hammer, every problem looks like a nail."

    Quote Originally Posted by Needles View Post
    At any rate, Ortho surgery is like the auto mechanics of medicine--- it's mostly mechanical correction.
    True, but I have heard horror stories about botched ortho surgeries with permanent nerve damage, etc.

    When at age 46 I broke my distal radius (not in 4 pieces with joint involvement, as mentioned earlier in this thread), I chose a local board certified hand surgeon who had competently repaired one of my friends' finger/hand fractures and who had previously advised me through my kneecap dislocation recovery. (He was on duty the morning I came in after popping the kneecap and putting it back in myself, and I was impressed that he did not try to push surgery.) He put my fingers in a traction device which looked like a Chinese finger puzzle, hung weights over my elbow, and worked the end of my radius back into place. Three weeks in a compression splint, plus three weeks in a short arm fiberglass cast, with weekly progress X-rays to make sure nothing had slipped out of place, and I was ready to rehab my range of motion and strength. I lost just over 5mm of forearm length and the distal ulnar bump in my wrist is more prominent than before, but I have full strength and range of motion.

    Surgery can work wonders when it is needed, but I have always been pleased with my nonsurgical repairs of the right radius and the left clavicle.
    "Early to bed, early to rise. Work like hell, and advertise." -- George Stahlman
    Capo [dschaw'-poe]: 1959 Modell Campagnolo, S/N 40324; 1960 Sieger, S/N 42624
    Peugeot: 1970 UO-8, S/N 0010468
    Bianchi: 1981 Campione d'Italia, S/N 1.M9914
    Schwinn: 1988 Project KOM-10, S/N F804069

  25. #25
    Senior Member tg16's Avatar
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    Your body is going to be cut open with a sharp object. After that, the exposed parts will be manipulated in hopes of fixing you. Finally, you will be stitched or stapled and overall there will be blood. There will also be foreign chemical substances introduced into your body.

    Are you going to trust the "opinion" of one person?

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